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Hatt D, Kupelian C, Stover LB, Pade K. Not Your Average Limping Toddler. Clin Pediatr (Phila) 2024:99228241235980. [PMID: 38450603 DOI: 10.1177/00099228241235980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Affiliation(s)
- Danielle Hatt
- Division of Pediatric Emergency Medicine, Rady Children's Hospital, San Diego, CA, USA
| | - Chloe Kupelian
- Division of Primary Hospital Medicine, Rady Children's Hospital, San Diego, CA, USA
| | | | - Kathryn Pade
- Division of Pediatric Emergency Medicine, Rady Children's Hospital, San Diego, CA, USA
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Choi GS, Boudier-Revéret M, Chang MC. The Short-Term Outcome of Transforaminal Epidural Steroid Injection in Patients with Radicular Pain Due to Foraminal Stenosis from Lumbar Isthmic Spondylolisthesis. J Pain Res 2024; 17:519-524. [PMID: 38328020 PMCID: PMC10849878 DOI: 10.2147/jpr.s441358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/30/2024] [Indexed: 02/09/2024] Open
Abstract
Purpose In this study, we evaluated the therapeutic outcomes of transforaminal epidural steroid injection (TFESI) in managing chronic radicular pain due to foraminal stenosis. Furthermore, we evaluated its effectiveness according to isthmic spondylolisthesis (IS) severity. Patients and Methods We included 40 patients with radicular pain due to IS-derived foraminal stenosis in our study and treated them with TFESI. Two patients were lost during follow-up. Based on the lateral lumbar radiograph findings, we allocated the recruited patients with < 25% slippage by IS to Group 1 (n = 23) and those having 25-50% slippage to Group 2 (n = 15). The degree of pain was measured using a numeric rating scale (NRS) at pre-treatment and 1 and 2 months after TFESI. Results In 38 patients who completed the study, the NRS at pre-treatment was significantly reduced at the 1- and 2-month follow-ups. In the Group analysis, the NRS scores were significantly reduced after TFESI in both Groups 1 and 2, regardless of IS severity. However, the reduction in NRS scores 1 month after TFESI was significantly greater in Group 1 than in Group 2. Moreover, the rate of successful treatment outcomes was significantly higher (65.2%) in Group 1 than in Group 2 (26.7%). Conclusion After TFESI, chronic radicular pain was significantly reduced regardless of IS severity, and its effect persisted for at least 2 months. However, its effect was superior when the vertebra slippage by IS was less than 25% compared to patients with 25%-50%.
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Affiliation(s)
- Gyu-Sik Choi
- Cheokbareun Rehabilitation Clinic, Pohang-si, Gyeonsangbuk-do, South Korea
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Loose O, Eberhardt O, Fernandez FF. [Stress injuries of bone in children and adolescents]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:839-847. [PMID: 37410116 DOI: 10.1007/s00113-023-01351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/07/2023]
Abstract
Stress injuries of bone in childhood and adolescence are the result of an imbalance between physical stress on the growing musculoskeletal system and its intrinsic resilience. Children who are very active in sports are particularly affected. The classical stress injuries mainly occur in the area of the lower leg, the metatarsus and the lower lumbar spine due to the disproportionate load on healthy bone; however, overuse syndromes can also occur in the area of the growth plates and possibly lead to growth plate disorders. The anamnesis usually shows stress-related pain that has existed for a long time without trauma. As part of the differential diagnosis, a stress injury must first be included in the considerations due to it being a rare entity. An X‑ray examination can show the first signs of a stress reaction. In the event of a conspicuous periosteal reaction, a malignant event must also be considered. As a rule, the MRI examination is then groundbreaking and in some rare cases biopsies have to be considered. The treatment of stress injuries is usually conservative. Recurrences should be counteracted by exercise control.
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Affiliation(s)
- Oliver Loose
- Olgahospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Deutschland.
| | - Oliver Eberhardt
- Olgahospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Deutschland
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Vallee EK, Lucasti C, Scott MM, Graham BC, Doak JP, Ferrick MR, Kowalski JM. A Readability Analysis of Online Spondylolisthesis and Spondylolysis Patient Resources Among Pediatric Hospital Web Pages: A US-Based Study. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202311000-00008. [PMID: 37967074 PMCID: PMC10653604 DOI: 10.5435/jaaosglobal-d-23-00177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/13/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION With the increasing use of the internet for health information, it is essential to prioritize resources that match the reading level of patients and parents. Limited health literacy is a notable issue in the United States, creating a financial burden and negatively affecting patient outcomes. This study aimed to assess the availability and readability of pediatric hospital web pages concerning two prevalent spine conditions in children, spondylolisthesis and spondylolysis, specifically examining whether the available resources meet the recommended sixth grade reading level. METHODS A total of 179 pediatric hospital web pages were assessed for their availability and readability of spondylolisthesis and spondylolysis patient information. The web pages' readability was assessed using five readability formulae. Descriptive statistics and Student t-tests were performed on the collected scores with significance set at P < 0.05. RESULTS Among the analyzed hospitals, 40.2% had no information on spondylolisthesis or spondylolysis, 20.1% mentioned treating these conditions, 7.8% had < 100 dedicated words, and only 31.8% had dedicated web pages with more than 100 words on these conditions. The average reading grade level for the evaluated web pages was 12.0, indicating a high school education level is required for comprehension. None of the web pages were written below the recommended sixth grade reading level. DISCUSSION The readability of the limited resources was markedly higher than the recommended reading level. In addition, this study emphasizes the need for enhanced accessibility and readability of online patient information from pediatric hospitals to improve parental comprehension and informed decision-making. Physicians should consider identifying online resources that they consider of high quality and acceptable readability to support better patient understanding and outcomes.
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Affiliation(s)
- Emily K. Vallee
- From the Jacobs School of Medicine and Biomedical Sciences (Ms. Vallee, Mr. Scott, Mr. Graham), and the UBMD Orthopaedics and Sports Medicine Doctors (Dr. Lucasti, Dr. Doak, Dr. Ferrick, Dr. Kowalski), University at Buffalo, Buffalo, NY
| | - Christopher Lucasti
- From the Jacobs School of Medicine and Biomedical Sciences (Ms. Vallee, Mr. Scott, Mr. Graham), and the UBMD Orthopaedics and Sports Medicine Doctors (Dr. Lucasti, Dr. Doak, Dr. Ferrick, Dr. Kowalski), University at Buffalo, Buffalo, NY
| | - Maxwell M. Scott
- From the Jacobs School of Medicine and Biomedical Sciences (Ms. Vallee, Mr. Scott, Mr. Graham), and the UBMD Orthopaedics and Sports Medicine Doctors (Dr. Lucasti, Dr. Doak, Dr. Ferrick, Dr. Kowalski), University at Buffalo, Buffalo, NY
| | - Benjamin C. Graham
- From the Jacobs School of Medicine and Biomedical Sciences (Ms. Vallee, Mr. Scott, Mr. Graham), and the UBMD Orthopaedics and Sports Medicine Doctors (Dr. Lucasti, Dr. Doak, Dr. Ferrick, Dr. Kowalski), University at Buffalo, Buffalo, NY
| | - Jeremy P. Doak
- From the Jacobs School of Medicine and Biomedical Sciences (Ms. Vallee, Mr. Scott, Mr. Graham), and the UBMD Orthopaedics and Sports Medicine Doctors (Dr. Lucasti, Dr. Doak, Dr. Ferrick, Dr. Kowalski), University at Buffalo, Buffalo, NY
| | - Michael R. Ferrick
- From the Jacobs School of Medicine and Biomedical Sciences (Ms. Vallee, Mr. Scott, Mr. Graham), and the UBMD Orthopaedics and Sports Medicine Doctors (Dr. Lucasti, Dr. Doak, Dr. Ferrick, Dr. Kowalski), University at Buffalo, Buffalo, NY
| | - Joseph M. Kowalski
- From the Jacobs School of Medicine and Biomedical Sciences (Ms. Vallee, Mr. Scott, Mr. Graham), and the UBMD Orthopaedics and Sports Medicine Doctors (Dr. Lucasti, Dr. Doak, Dr. Ferrick, Dr. Kowalski), University at Buffalo, Buffalo, NY
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Matsuzawa K, Matsui T, Azuma Y, Miyazaki T, Hiramoto M, Hashimoto R, Kida N, Morihara T. Spine Alignment in Standing and Maximal Upper Limb Elevation in Baseball Players with Lumbar Spondylolysis and Those without Low Back Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3231. [PMID: 36833924 PMCID: PMC9965598 DOI: 10.3390/ijerph20043231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/02/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
The changes in lumbar lordosis angle (LL) and sacral slope angle (SS) related to upper limb elevation and thoracic kyphosis angle (TK) in baseball players with spondylolysis remain unclear. Herein, we investigated baseball players with spondylolysis and those without low back pain, comparing LL and SS with upper limb elevation within and between groups and TK between groups. Baseball players with spondylolysis were enrolled as subjects, and baseball players without low back pain were enrolled as controls (n = 8 each). X-rays were obtained in the standing position and with maximal elevation position of the upper limb (elevation position). LL and SS were measured in the standing and elevated positions, and TK was measured in the standing position. LL was significantly larger in individuals with spondylolysis than controls. The SS of the control group was significantly larger in the elevated position than in the standing position, while the SS of the spondylolysis group was not significantly different between positions. SS was significantly larger in the spondylolysis group than in the control group, only in the standing position. Physical therapy for spondylolysis should focus on hyperlordosis alignment in the standing and maximal elevation positions of both upper limbs, sacral hyper-slope alignment in the standing position, and decreased sacral slope motion.
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Affiliation(s)
- Kanta Matsuzawa
- Marutamachi Rehabilitation Clinic, Kyoto 604-8405, Japan
- Department of Biotechnology, Graduate School of Science and Technology, Kyoto Institute of Technology, Kyoto 606-0951, Japan
| | | | | | - Tetsuya Miyazaki
- Marutamachi Rehabilitation Clinic, Kyoto 604-8405, Japan
- Department of Biotechnology, Graduate School of Science and Technology, Kyoto Institute of Technology, Kyoto 606-0951, Japan
| | | | - Ruo Hashimoto
- Marutamachi Rehabilitation Clinic, Kyoto 604-8405, Japan
| | - Noriyuki Kida
- Department of Biotechnology, Graduate School of Science and Technology, Kyoto Institute of Technology, Kyoto 606-0951, Japan
| | - Toru Morihara
- Marutamachi Rehabilitation Clinic, Kyoto 604-8405, Japan
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Matsuzawa K, Matsui T, Azuma Y, Miyazaki T, Hiramoto M, Hashimoto R, Kida N, Morihara T. Comparison of alignment and spondylolysis fracture angle in bilateral and unilateral spondylolysis. PLoS One 2022; 17:e0276337. [PMID: 36256612 PMCID: PMC9578603 DOI: 10.1371/journal.pone.0276337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/04/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Spondylolysis occurs bilaterally or unilaterally and bilateral spondylolysis increases the risk of developing isthmic spondylolisthesis. The characteristics of the lumbar lordosis angle (LLA), sacral slope angle (SSA), and spondylolysis fracture angle (SFA) in bilateral spondylolysis compared with those in unilateral spondylolysis have not been clarified. The purpose of this study was to compare the LLA, SSA, and SFA of bilateral and unilateral spondylolysis. MATERIALS AND METHODS Thirty-eight patients with lumbar spondylolysis who visited our clinic for an initial visit and 15 age-matched patients with a chief complaint of low back pain were included as controls. Computed tomography films were used to classify all spondylolysis patients into two groups: those with bilateral fractures (bilateral) and those with unilateral fractures (unilateral). The LLA and SSA were measured using lateral X-ray films and the SFA was measured using computed tomography films. RESULTS The LLA was significantly higher in all spondylolysis patients than in the control group (p = .026). There was no significant difference in SSA between the spondylolysis and control groups (p = .28). The LLA was significantly higher in the bilateral group than in the unilateral group (p = .018). There was no significant difference in SSA between the bilateral and unilateral groups (p = .15). The SFA was significantly lower in the bilateral group than in the unilateral group (p = .024). CONCLUSIONS This study suggests that physical therapy for spondylolysis may be considered bilaterally and unilaterally.
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Affiliation(s)
- Kanta Matsuzawa
- Marutamachi Rehabilitation Clinic, Kyoto, Japan
- Department of Biotechnology, Graduate School of Science and Technology, Kyoto Institute of Technology, Kyoto, Japan
- * E-mail:
| | | | | | - Tetsuya Miyazaki
- Marutamachi Rehabilitation Clinic, Kyoto, Japan
- Department of Biotechnology, Graduate School of Science and Technology, Kyoto Institute of Technology, Kyoto, Japan
| | | | | | - Noriyuki Kida
- Department of Biotechnology, Graduate School of Science and Technology, Kyoto Institute of Technology, Kyoto, Japan
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Li N, Scofield J, Mangham P, Cooper J, Sherman W, Kaye A. Spondylolisthesis. Orthop Rev (Pavia) 2022; 14:36917. [PMID: 35910544 DOI: 10.52965/001c.36917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 11/06/2022] Open
Abstract
Spondylolisthesis refers to the anterior, lateral, or posterior slippage of a superior vertebral disc over the adjacent inferior disc, and is often separated into categories based on the causative etiology. Spondylolisthesis is often asymptomatic but may present with low back pain and neurogenic claudication which is worsened with spinal extension and activity. A detailed history and physical exam, along with appropriate imaging tests are useful in making the diagnosis. Conservative therapy is first-line and includes pain management with physical therapy. Patients who fail conservative therapy may consider surgical decompression, stabilization, and fusion. This review aims to discuss the epidemiology, pathophysiology, presentation, and treatment options of spondylolisthesis.
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Affiliation(s)
| | | | | | | | | | - Alan Kaye
- Louisiana State University Shreveport
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Linton AA, Hsu WK. A Review of Treatment for Acute and Chronic Pars Fractures in the Lumbar Spine. Curr Rev Musculoskelet Med 2022; 15:259-271. [DOI: 10.1007/s12178-022-09760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/24/2022]
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Kolenko AMG, Bauer JM. A delayed diagnosis of high-grade spondylolisthesis. JAAPA 2022; 35:38-41. [PMID: 35192553 DOI: 10.1097/01.jaa.0000805816.85664.a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Spondylolysis, or pars defect, occurs in nearly half of children with back pain. Despite the marked prevalence, diagnosis of spondylolysis with spondylolisthesis often is delayed or missed secondary to referred pain and uncharacteristic presentation. This article describes an 8-year-old patient with 15 months of right heel pain who was initially treated by her primary care provider for presumed Sever disease before being referred to orthopedics. After orthopedic consultation, she was diagnosed with a high-grade spondylolisthesis with L5 nerve root compression. Although spondylolysis is an infrequent diagnosis, particularly in a patient this young, missing the diagnosis can significantly reduce a patient's quality of life.
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Affiliation(s)
- Ana Maria G Kolenko
- Ana Maria G. Kolenko practices in pediatric orthopedic spine surgery at Seattle (Wash.) Children's Hospital. Jennifer M. Bauer is a pediatric orthopedic spine surgeon at Seattle Children's Hospital and an assistant professor of orthopedic surgery at the University of Washington in Seattle. Dr. Bauer discloses that she is a consultant for Synthes DePuy, the orthopedic company of Johnson & Johnson. The authors have disclosed no other potential conflicts of interest, financial or otherwise
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Chen SR, Gibbs CM, Zheng A, Dalton JF, Gannon EJ, Shaw JD, Ward WT, Lee JY. Use of L5-S1 transdiscal screws in the treatment of isthmic spondylolisthesis: a technical note. JOURNAL OF SPINE SURGERY (HONG KONG) 2021; 7:510-515. [PMID: 35128125 PMCID: PMC8743294 DOI: 10.21037/jss-21-73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/15/2021] [Indexed: 06/14/2023]
Abstract
Surgical treatment of L5-S1 isthmic spondylolisthesis consists of a combination of decompression and fusion. One previously discussed mode of fusion is via transdiscal screws. Biomechanical studies of transdiscal screws have demonstrated greater rigidity than traditional pedicle screw fixation, which theoretically translates to a higher fusion rate. Furthermore, when compared to pedicle screw fixation, transdiscal screw fixation also demonstrates improved functional and radiographic outcomes. However, transdiscal screw placement can be technically difficult. At this time, a detailed surgical technique has yet to be reported in the literature. Our surgical technique for transdiscal screw placement using intraoperative C-arm at L5-S1 is described. We include considerations for preoperative planning including necessary imaging and appropriate patient selection. We also discuss intraoperative concerns such as setup, surgical approach, proper screw trajectory, and our method for achieving indirect decompression. The results of thirteen consecutive patients treated with transdiscal screw fixation are described. One patient had subcutaneous seroma requiring reoperation (7.7%), three patients had implant failure (23.1%), and one patient had nonunion (7.7%). Our results suggest that transdiscal screw fixation is a safe and acceptable alternative for stabilization and indirect decompression of L5-S1 isthmic spondylolisthesis. Recent innovation in intraoperative navigation and robotic surgery may lessen the technical difficulty of transdiscal screw placement and make it even more effective.
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Orthopaedic Management of Loeys-Dietz Syndrome: A Systematic Review. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202111000-00005. [PMID: 34779796 PMCID: PMC8594655 DOI: 10.5435/jaaosglobal-d-21-00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
Introduction: Loeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder associated with aortic aneurysm/dissection in children. However, LDS may also present with a host of orthopaedic conditions. This study aimed to elucidate the management of orthopaedic conditions and associated outcomes in patients with LDS. Methods: PubMed, Ovid MEDLINE, and Cochrane Library were systematically searched for primary articles regarding the management of orthopaedic conditions in patients with LDS. The goals and findings of each included study were described. Data regarding demographics, conditions studied, treatment modalities, and outcomes were extracted and analyzed. Results: Three hundred sixty-two unique articles were retrieved, 13 of which were included, with 4 retrospective cohort studies and 9 case reports representing 435 patients. In total, 19.8% of patients presenting with orthopaedic conditions received surgical treatment;54.3% of them experienced adverse outcomes, and 44.4% required revision surgery. The mean age at surgery was 9.0 ± 2.1 years. Conclusion: Patients with LDS may require early surgical intervention for a variety of orthopaedic conditions and may be at an increased risk for surgical complications. The current LDS literature is primarily focused on spinal conditions with a relative paucity of data on the management of hip deformity, joint subluxation, clubfoot, and trauma. Additional research is required regarding orthopaedic management for this unique population.
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Zhang ZC, Zhang Y, Zhang LZ, Guan K, Zhao GM, Ren DJ, Li F, Sun TS. Repair of symptomatic bilateral L5 spondylolysis with autogenous iliac crest graft and temporary intersegmental pedicle screw fixation in youth. J Orthop Surg Res 2021; 16:422. [PMID: 34215290 PMCID: PMC8252200 DOI: 10.1186/s13018-021-02534-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/08/2021] [Indexed: 01/01/2023] Open
Abstract
Background When symptomatic spondylolysis fail to respond to nonoperative treatment, surgical management may be required. A number of techniques have been described for repair by intrasegmental fixation with good results; however, there are still some problems. We reported a repair technique with temporary intersegmental pedicle screw fixation and autogenous iliac crest graft. The aim of present study is to assess the clinical outcomes of L5 symptomatic spondylolysis with this technique. Methods A retrospective analysis of 128 patients with L5 spondylolysis treated with this method was performed. According to CT scan, the spondylolysis were classified into 3 categories: line, intermediate, and sclerosis type. The diagnostic block test of L5 bilateral pars defect was done in all patients preoperatively. The sagittal and axial CT images were used to determine the bone union. The healing time, complications, number of spina bifida occulta, Japanese Orthopedic Association (JOA) score, and VAS for back pain were recorded. After fixation removal, the rate of ROM preservation at L5S1 was calculated. Results There were 97 patients (194 pars) followed with mean follow-up of 23 months (range, 12–36 months). The union rate of pars was 82.0% at 12 months and 94.3% at 24 months postoperatively. Low back pain VAS significantly (P < 0.05) improved from preoperative mean value of 7.2 to 1.3 at the final follow-up postoperatively (P < 0.05). JOA score increased significantly postoperatively (P < 0.05) with average improvement rate of 79.3%. The rates of L5S1 ROM preservation were 79.8% and 64.0% after fixation removal at 1 and 2 years postoperatively. There were 3 patients of delayed incision healing without other complications. Conclusions Although sacrificing L5S1 segment motion temporarily, more stability was obtained with intersegmental fixation. This technique is reliable for spondylolysis repair which has satisfactory symptom relief, high healing rate, low incidence of complications, and preserve a large part of ROM for fixed segment.
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Affiliation(s)
- Zhi-Cheng Zhang
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Yang Zhang
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Li-Zhi Zhang
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Kai Guan
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Guang-Min Zhao
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Da-Jiang Ren
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Fang Li
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China.
| | - Tian-Sheng Sun
- Department of Orthopedic, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
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Du CZ, Zhu ZZ, Wang Y, Li S, Xu L, Wang B, Qiu Y, Sun X. Curve Characteristics and Response of Sciatic and Olisthesis Scoliosis Following L5/S1 Transforaminal Lumbar Interbody Fusion in Adolescent Lumbar Spondylolisthesis. Neurosurgery 2021; 88:322-331. [PMID: 33017018 DOI: 10.1093/neuros/nyaa429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 07/02/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Lumbosacral spondylolisthesis-induced scoliosis is a rare clinical entity. Sagittal reconstruction and the coronal curve evolution after surgery for spondylolisthesis have not been investigated in depth. OBJECTIVE To compare the curve characteristics between sciatic scoliosis and olisthetic scoliosis and to further investigate the effects of lumbosacral transforaminal lumbar interbody fusion (TLIF) on scoliosis evolution. METHODS Adolescents with sciatic scoliosis group (SS group) or olisthetic scoliosis group (OS group) who underwent L5/S1 TLIF from 2010 to 2017 and were followed up for at least 2 yr were retrospectively reviewed. Radiographic parameters and patient-reported outcomes were evaluated. RESULTS There were 20 patients in the SS group (M/F: 8/12; age: 15.6 ± 2.2 yr) and 16 in the OS group (M/F: 6/10; age: 16.8 ± 2.5 yr). Both groups had similar preoperative Cobb angles, but more patients with coronal imbalance were observed in the SS group. Moreover, the OS group showed significantly larger L5 tilt and rotation. After surgery, the slip reduction rate of the SS group and OS group were 76.1% ± 12.4% and 79.4% ± 9.6%, respectively. Scoliosis resolution was observed in all patients in the SS group but only in 9 patients (56.2%) in the OS group. Patients with failed scoliosis resolution in the OS group were older and had a larger Cobb angle and L5 rotation compared with those with successful scoliosis resolution. CONCLUSION Lumbosacral TLIF can achieve satisfactory slip reduction and scoliosis resolution. Sciatic scoliosis often presents with coronal imbalance but also a preferable curve prognosis. A large Cobb angle and L5 rotation may hinder the resolution of olisthetic scoliosis.
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Affiliation(s)
- Chang-Zhi Du
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Ze-Zhang Zhu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Yu Wang
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Song Li
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Liang Xu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bin Wang
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Xu Sun
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
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Abstract
Back pain has long been considered an uncommon complaint in the pediatric population. When present, teaching had been that pediatric back pain almost always has a diagnosable cause, many of which are progressive and potentially debilitating. Recent evidence has suggested that pediatric back pain is not only more common than once thought but also, within certain populations, benign and idiopathic. This, in turn, places an increasing amount of pressure on pediatricians to accurately assess and manage their patients presenting with complaints of back pain. The aim of this article is to serve as a review of the current literature on pediatric back pain. The article reviews the epidemiology, basic anatomy, and important elements of a history and examination, which should be considered when a child presents complaining of back pain. Last, a common differential diagnosis with evaluation and management is also given to help guide pediatricians through their medical decision making.
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Affiliation(s)
- Micah Lamb
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Joel S Brenner
- Children's Specialty Group PLLC, Norfolk, VA.,Children's Hospital of The King's Daughters, Norfolk, VA.,Eastern Virginia Medical School, Norfolk, VA
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Du CZ, Li S, Xu L, Zhou QS, Zhu ZZ, Sun X, Qiu Y. Sagittal reconstruction of lumbosacral contiguous double-level spondylolytic spondylolisthesis: a comparison of double-level and single-level transforaminal lumbar interbody fusion. J Orthop Surg Res 2019; 14:148. [PMID: 31122245 PMCID: PMC6533736 DOI: 10.1186/s13018-019-1197-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/14/2019] [Indexed: 12/24/2022] Open
Abstract
Background Contiguous double-level lumbar spondylolytic spondylolisthesis is an extremely rare condition. There is a paucity of data of lumbosacral deformity and sagittal spino-pelvic malalignment among these patients. Moreover, the effect of transforaminal lumbar interbody fusion (TLIF) on sagittal realignment still remains largely unknown. The aim of the study is to investigate the reconstruction of sagittal alignment and the improvement of clinical outcomes after posterior instrumented double-level or single-level TLIF. Methods From January 2010 to September 2018, the records of patients with contiguous L4/5 and L5/S1 double-level spondylolytic spondylolisthesis were retrospectively reviewed. Patients who had undergone double-level or single-level TLIF and a minimum of 2 years’ follow-up were included. The slippage parameters and spino-pelvic parameters were measured preoperatively, postoperatively, and at the latest follow-up. Results A total of 58 patients (21 males and 37 females, mean age of 57.1 ± 6.9 years) were enrolled. Thirty-eight patients were treated with double-level TLIF and the remaining 20 with single-level TLIF (L4/5 in 14; L5/S1 in 6). After surgery, the spondylolisthesis was significantly reduced at both L4/5 and L5/S1 level (all P < 0.001). There was a significant reduction in pelvic tilt (P < 0.001) and a significant increase in sacral slope (P < 0.001). Significant increase in L4–S1 height (P < 0.001) and L4–S1 lordosis (P = 0.012) and decrease in L5 slope (P = 0.004) and L5 incidence (P = 0.001) were also observed. Compared to single-level TLIF, double-level TLIF increased L4–S1 height (P < 0.001) and L4–S1 lordosis (P < 0.001) and reduced L4-SVA (P = 0.007) and L5 incidence (P = 0.013) more obviously, and the sagittal balance was better corrected in double-level TLIF group (P = 0.006). Double-level TLIF group showed larger increase in VAS scores for low back pain. The incidence of implant-related complications was lower in the double-level group. Conclusion Posterior short-segment instrumented TLIF can bring favorable radiographic and clinical outcomes in patients with lumbosacral contiguous double-level spondylolytic spondylolisthesis. Double-level TLIF is more efficient to improve L4–S1 height, regional lumbar lordosis, and global sagittal balance.
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Affiliation(s)
- Chang-Zhi Du
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China
| | - Song Li
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Liang Xu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Qing-Shuang Zhou
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China
| | - Ze-Zhang Zhu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Xu Sun
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China.
| | - Yong Qiu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China.
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Abstract
PURPOSE OF REVIEW Provide a comprehensive overview of lumbar spondylolysis, a frequent cause of lower back pain in children and adolescents, from evaluation to management. RECENT FINDINGS With the surge of structured sports participation in the pediatric population, spondylolysis is a common ailment that afflicts many young athletes due to rigorous competition that taxes the growing spine with repetitive extension and rotation. SUMMARY Spondylolysis is a fracture through the pars interarticularis. When a child presents with lower back pain, spondylolysis should be at the top of the differential. A thorough history and physical examination are essential. In addition, radiographs of the lumbar spine, anterior posterior and lateral views, MRI and, selectively, computed tomography are useful adjuncts to uncover a pars injury. Timely diagnosis facilitates early treatment which includes rest, optimizing bone health, brace treatment, and physical therapy. If delayed or untreated, spondylolysis may result in nonunion or pars defect. If symptomatic, patients may need surgery to fuse the lumbar facet joints or repair the par interarticularis.
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Duffin TS, Thomas SW. Retrospondyloptosis of the Spine Secondary to Nonaccidental Trauma. Case Rep Pediatr 2018; 2018:4526560. [PMID: 30018837 PMCID: PMC6029492 DOI: 10.1155/2018/4526560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/17/2018] [Indexed: 11/17/2022] Open
Abstract
Spinal fracture rates from NAT have been reported in <1-3% of spinal injury cases. We present a 13-month-old female who presented with signs of spinal cord injury and was found to have complete retrospondylolisthesis of T12 vertebra and multiple rib fractures in various stages of healing due to NAT. This case reports an extremely severe spinal injury due to NAT of which there are few in the literature and highlights the importance of suspicion of NAT when pediatric patients present with neurologic symptoms and spinal trauma without plausible mechanism of injury.
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Affiliation(s)
- T. S. Duffin
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - S. W. Thomas
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
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A Grade IV Isthmic Spondylolisthesis. J Orthop Sports Phys Ther 2017; 47:971. [PMID: 29191121 DOI: 10.2519/jospt.2017.7547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 15-year-old adolescent boy was referred by an orthopaedic surgeon for treatment of right gluteal and thigh pain. Following treatment that reduced his pain, he experienced acute onset of bilateral radiculopathy. He was referred back to the physician, who ordered radiographs and magnetic resonance imaging, which identified a grade IV isthmic spondylolisthesis at the L5-S1 level. J Orthop Sports Phys Ther 2017;47(12):971. doi:10.2519/jospt.2017.7547.
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